Basic Information
| Provider Information | |||||||||
| NPI: | 1770710709 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MONTAGE MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 480 | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939020480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316491000 | ||||||||
| FaxNumber: | 8316494966 | ||||||||
| Practice Location | |||||||||
| Address1: | 275 THE CROSSROADS BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939238685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316583639 | ||||||||
| FaxNumber: | 8316430103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2009 | ||||||||
| LastUpdateDate: | 06/25/2021 | ||||||||
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| AuthorizedOfficialLastName: | MCMILLAN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8316491000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MONTAGE HEALTH | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.